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  1. 2. Introduction <ul><li>This presentation will help you </li></ul><ul><ul><li>better understand and manage your diabetes. </li></ul></ul><ul><ul><li>It covers the three main forms of diabetes, type 1 and type 2, as well as gestational diabetes. </li></ul></ul><ul><ul><li>how your body metabolizes sugar, </li></ul></ul><ul><ul><li>How to control diabetes </li></ul></ul><ul><ul><li>the fundamentals of nutrition and exercise. </li></ul></ul><ul><ul><li>up-to-date information about recent innovations in treatment and </li></ul></ul><ul><ul><li>most importantly, you'll see that it's not just possible to live with diabetes; it's possible to live well. </li></ul></ul>Dr. Sunita Gupta
  2. 3. <ul><li>Insulin is the principal hormone in the body </li></ul><ul><ul><li>It plays a key role in all forms of diabetes mellitus. </li></ul></ul><ul><ul><li>It regulates uptake of glucose from the bloodstream into every muscle and all fat cells, </li></ul></ul><ul><ul><li>But not into the cells of the central nervous system. </li></ul></ul><ul><li>Deficiency of insulin or insensitivity of its receptors </li></ul><ul><ul><li>Causes Diabetes Miletus </li></ul></ul>Dr. Sunita Gupta
  3. 4. When our body functions normally … The normal food processing cycle <ul><li>food is converted to glucose before it is used by the blood and body as fuel. </li></ul><ul><li>As a result, blood glucose levels in the body rise. </li></ul><ul><li>In response to this, the Pancreas release Insulin into the blood. </li></ul>Dr. Sunita Gupta
  4. 5. When our body functions normally … The different organs involved in the normal food processing cycle <ul><li>about two-thirds of the body's cells use Insulin to </li></ul><ul><li>absorb glucose from the blood </li></ul><ul><li>To use as fuel and </li></ul><ul><li>To convert to other needed chemicals, or </li></ul><ul><li>for storage. </li></ul>Dr. Sunita Gupta
  5. 6. Normal glucose absorption Insulin binds to receptors on the cell membrane, much as a key fits into a lock, signal glucose transporters Glucose transporters move to the cell membrane and bind to glucose. Glucose enters the cell. Dr. Sunita Gupta
  6. 7. When the system fails to absorb glucose…. <ul><li>Type 1 Diabetes </li></ul><ul><li>Type 2 Diabetes </li></ul>Dr. Sunita Gupta An immune system attack severely limits the ability of the pancreas to produce insulin Glucose cannot enter the cells. <ul><li>Cells develop a resistance to insulin. Glucose builds up in the bloodstream. </li></ul>
  7. 8. When the insulin is high/ low <ul><li>Higher insulin levels increase certain processes, like </li></ul><ul><ul><li>cell growth and duplication, </li></ul></ul><ul><ul><li>protein synthesis, and </li></ul></ul><ul><ul><li>fat storage. </li></ul></ul><ul><li>If the amount of insulin available is insufficient due to </li></ul><ul><ul><li>insulin insensitivity or resistance - poor response of the cells </li></ul></ul><ul><ul><li>defective insulin, then glucose will </li></ul></ul><ul><ul><ul><li>neither be absorbed properly by those body cells that require it </li></ul></ul></ul><ul><ul><ul><li>nor will it be stored appropriately in the liver and muscles. </li></ul></ul></ul><ul><li>The net effect – </li></ul><ul><ul><li>persistent high levels of blood glucose, </li></ul></ul><ul><ul><li>poor protein synthesis, and </li></ul></ul><ul><ul><li>other metabolic derangements, such as acidosis. </li></ul></ul>Dr. Sunita Gupta
  8. 9. When the body begins to malfunction… <ul><li>Glucose, after food is absorbed from the intestines </li></ul><ul><ul><li>and distributed to all the body cells through the bloodstream. </li></ul></ul><ul><li>The glucose concentration in the blood </li></ul><ul><ul><li>body keeps constant and avoids extra glucose right after every meal </li></ul></ul><ul><ul><li>and starves the body between the meals and overnight. </li></ul></ul>The defective food processing cycle Dr. Sunita Gupta
  9. 10. When the body begins to malfunction… <ul><li>When glucose in the body is excess </li></ul><ul><ul><li>stored in the liver and muscles as glycogen . </li></ul></ul><ul><li>When glucose is in short supply, </li></ul><ul><ul><li>the body stimulates to eat food and/or mobilizes the stored glycogen. </li></ul></ul><ul><li>To maintain a constant blood-glucose level, </li></ul><ul><ul><li>the body relies on pancreas to produce two hormones insulin and glucagon </li></ul></ul>Insulin vs Glucagon cycle – A comparison Dr. Sunita Gupta
  10. 11. Diabetes mellitus <ul><li>Diabetes mellitus (or simply diabetes) is a condition when: </li></ul><ul><li>the organism begins to malfunction – metabolic disorder </li></ul><ul><li>levels of the hormone insulin in the blood become insufficient </li></ul><ul><li>the body cells fail to respond to the insulin that is produced, or both. </li></ul><ul><li>as a result, blood sugar levels grow abnormally high (hyperglycaemia) </li></ul><ul><li>This is Diabetes and is not curable. </li></ul>
  11. 12. Types of Diabetes <ul><li>Diabetes mellitus – </li></ul><ul><li>Three main forms (WHO): </li></ul><ul><li>type 1 , </li></ul><ul><li>type 2 , and </li></ul><ul><li>gestational diabetes </li></ul><ul><li>(occurs during pregnancy) </li></ul>Dr. Sunita Gupta
  12. 13. SYMPTOMS <ul><li>The characteristic symptoms are </li></ul><ul><li>excessive urine production (polyuria) due to high blood glucose levels, </li></ul><ul><li>excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, </li></ul><ul><li>blurred vision due to high blood glucose effects on the eye's optics, </li></ul><ul><li>unexplained weight loss, and </li></ul><ul><li>lethargy. </li></ul>Dr. Sunita Gupta
  13. 14. Statistical breakup of symptoms Dr. Sunita Gupta
  14. 15. CAUSES of Diabetes mellitus <ul><li>Type 1 diabetes - when the pancreatic cells are destroyed due to autoimmune system of the body. </li></ul><ul><li>Type-2 diabetes - when due to high levels of blood sugar, the body is unable to utilize it’s insulin and move blood sugar into the cells to produce energy. </li></ul><ul><li>Gestational diabetes : the hormones produced during pregnancy can cause insulin resistance in women genetically prone to develop Diabetes. </li></ul>Dr. Sunita Gupta
  15. 16. Diabetes - a genetic source? <ul><li>Partly inheritance - Both type 1 and type 2 diabetes. </li></ul><ul><li>At least 10 genes found - links to the causes of Type-2 diabetes. </li></ul>Dr. Sunita Gupta
  16. 17. How genes influence Diabetes? <ul><li>Type 1 diabetes is triggered </li></ul><ul><ul><li>by some (mainly viral) infections, </li></ul></ul><ul><ul><li>by stress or environmental exposure (such as exposure to certain chemicals or drugs). </li></ul></ul><ul><li>Type 2 diabetes - a stronger inheritance pattern. </li></ul><ul><ul><li>If first relatives have type 2 diabetes </li></ul></ul><ul><ul><li>risk of developing type 2 diabetes is much higher. </li></ul></ul><ul><ul><li>This risk increases with increase in number of relatives with diabetes. </li></ul></ul>Dr. Sunita Gupta
  17. 18. diagnosis <ul><li>Recurrent or persistent hyperglycaemia during Diabetes mellitus is diagnosed by any one of the following methods: </li></ul><ul><ul><li>fasting plasma glucose level </li></ul></ul><ul><ul><ul><li>at or above 126 mg/dL (7.0 mmol/l). </li></ul></ul></ul><ul><ul><li>plasma glucose </li></ul></ul><ul><ul><ul><li>at or above 200 mg/dL (11.1 mmol/l) two hours after a 75 g oral glucose load. </li></ul></ul></ul><ul><ul><li>random plasma glucose </li></ul></ul><ul><ul><ul><li>at or above 200 mg/dL (11.1 mmol/l). </li></ul></ul></ul>Dr. Sunita Gupta
  18. 19. Diabetes screening <ul><li>Diabetes screening is recommended </li></ul><ul><ul><li>at various stages of life, and </li></ul></ul><ul><ul><li>For those with any of several risk factors. </li></ul></ul><ul><li>Diabetes screening could be </li></ul><ul><ul><li>a random blood glucose test, </li></ul></ul><ul><ul><li>a fasting blood glucose test, </li></ul></ul><ul><ul><li>a blood glucose test two hours after 75 g of glucose, or </li></ul></ul><ul><ul><li>a more formal glucose tolerance test. </li></ul></ul>Dr. Sunita Gupta
  19. 20. Diabetes and Obesity <ul><li>The diabetes - an epidemic </li></ul><ul><li>because in such a short time, like infectious diseases, it has spread so quickly. </li></ul><ul><ul><li>Excess body fat is the leading controllable risk factor type 2 diabetes. </li></ul></ul><ul><ul><li>Indians lead the world in the number of diabetic patients. </li></ul></ul><ul><ul><li>Alarming rise in obesity and diabetes around the world – </li></ul></ul><ul><ul><li>Diets high in saturated fat and refined carbohydrates and the modern sedentary lifestyle. </li></ul></ul>Dr. Sunita Gupta <ul><li>Here's how all those burgers and shakes add up: </li></ul><ul><ul><li>Worldwide, more than 1 billion adults are overweight or obese, </li></ul></ul><ul><ul><li>Roughly 300 million considered obese. </li></ul></ul><ul><ul><li>In 1985, about 30 million people had diabetes. </li></ul></ul><ul><ul><li>By 2025, 350 million, or more than 10 times as many will suffer from this disease. </li></ul></ul><ul><ul><li>Worldwide, the disease is the fourth leading cause of death. </li></ul></ul>
  20. 21. Incidence of diabetes between men and women Relation between BMI and incidence of diabetes Prevalence of diabetes between men and women across age Dr. Sunita Gupta
  21. 22. Impact of Diabetes on other diseases - complications Dr. Sunita Gupta
  22. 23. Complications from Diabetes <ul><li>Careless treatment or its poor management lead to serious complications ….. </li></ul><ul><li>Diabetes causes: </li></ul><ul><ul><li>Damage to eyes </li></ul></ul><ul><ul><li>heart disease and stroke, </li></ul></ul><ul><ul><li>retinal damage (blindness), </li></ul></ul><ul><ul><li>chronic renal (kidney) failure, </li></ul></ul><ul><ul><li>Poor healing of wounds (gangrene) </li></ul></ul><ul><ul><li>amputations </li></ul></ul><ul><ul><li>Impotence and difficulty passing urine in adults. </li></ul></ul>Dr. Sunita Gupta
  23. 24. Acute complications from Diabetes <ul><li>If Diabetes is not controlled properly, </li></ul><ul><li>acute complications may occur, like </li></ul><ul><li>dehydration </li></ul><ul><li>hypoglycemia, </li></ul><ul><li>ketosis, </li></ul><ul><li>acidosis. </li></ul><ul><li>Coma and </li></ul><ul><li>Even death </li></ul>Dr. Sunita Gupta
  24. 25. Deaths from different diseases due to complications of diabetes, 2005 (India) Dr. Sunita Gupta
  25. 26. TREATMENT <ul><li>Type 1 diabetes directly treatable </li></ul><ul><ul><li>only with injected insulin </li></ul></ul><ul><ul><li>(insufficient or no insulin from pancreas) </li></ul></ul><ul><ul><li>dietary and lifestyle changes </li></ul></ul><ul><li>Type 2 diabetes requires </li></ul><ul><ul><li>dietary treatment together with </li></ul></ul><ul><ul><ul><li>tablets </li></ul></ul></ul><ul><ul><ul><li>injections and, </li></ul></ul></ul><ul><ul><ul><li>frequent insulin supplementation. </li></ul></ul></ul>Dr. Sunita Gupta
  26. 27. Prevention <ul><li>Other health problems that accelerate the toxic effects of diabetes are </li></ul><ul><ul><li>obesity, </li></ul></ul><ul><ul><li>high blood pressure, and </li></ul></ul><ul><ul><li>lack of regular exercise. </li></ul></ul><ul><ul><li>elevated cholesterol levels, </li></ul></ul><ul><ul><li>smoking, </li></ul></ul><ul><li>Women with high bp must be careful. They have a threefold greater risk of developing diabetes. </li></ul><ul><li>For people with well-controlled blood sugar levels, the complications of diabetes are far less common and less severe, </li></ul><ul><li>it is vital that for prevention of diabetes to organize </li></ul><ul><ul><li>Patient education, </li></ul></ul><ul><ul><li>His understanding of the disease, and </li></ul></ul><ul><ul><li>His participation in treatment. </li></ul></ul>Dr. Sunita Gupta
  27. 28. Lifestyle changes - Type 1 diabetes <ul><li>Make Changes in lifestyle </li></ul><ul><ul><li>take drugs to reduce pressure. </li></ul></ul><ul><ul><li>take an appropriate diet, </li></ul></ul><ul><ul><li>quit smoking, </li></ul></ul><ul><ul><li>Exercise more, </li></ul></ul><ul><ul><li>wear diabetic socks, </li></ul></ul><ul><li>to avoid higher risks of cardiovascular disease, </li></ul><ul><li>to control blood pressure and cholesterol </li></ul><ul><li>Combine the use of regular and/or synthetic insulin for better results </li></ul>Dr. Sunita Gupta
  28. 29. Lifestyle changes - Type 2 diabetes <ul><li>Reduce the risk of long term complications: </li></ul><ul><li>This is achievable by combining </li></ul><ul><ul><li>diet, </li></ul></ul><ul><ul><li>exercise and </li></ul></ul><ul><ul><li>weight loss (type 2), </li></ul></ul><ul><ul><li>various oral diabetic drugs (type 2 only), and </li></ul></ul><ul><ul><li>insulin use – when not responding to oral medications (more for type 2 than type 1). </li></ul></ul>Dr. Sunita Gupta
  29. 30. Life-style dietary changes Dr. Sunita Gupta Smaller helpings Bigger helpings Moderate helpings
  30. 31. Conclusion <ul><li>Diabetes mellitus is </li></ul><ul><ul><li>a chronic disease, </li></ul></ul><ul><ul><li>without a cure. </li></ul></ul><ul><li>Emphasize on role for </li></ul><ul><ul><li>patient education, </li></ul></ul><ul><ul><li>dietetic support, </li></ul></ul><ul><ul><li>sensible exercise, </li></ul></ul><ul><ul><li>self glucose monitoring (both short and long term glucose blood levels within normal standards). </li></ul></ul><ul><ul><li>avoid short and long-term diabetes-related problems </li></ul></ul><ul><ul><li>Careful control to reduce the risk of long term complications. </li></ul></ul>Dr. Sunita Gupta
  31. 32. Some tips for avoiding complications <ul><li>Keep blood sugar levels as close to normal as possible </li></ul><ul><li>Keep blood pressure under 130/80 mm Hg. </li></ul><ul><li>Aim to keep LDL (unhealthy) cholesterol levels under 100 mg/dl, </li></ul><ul><li>Aim to keep HDL (healthy) cholesterol levels over 40 mg/dl, </li></ul><ul><li>Aim to keep triglyceride levels under 150 mg/dl. </li></ul><ul><li>Practice good foot care (see &quot;Damage to the feet and legs&quot;). </li></ul><ul><li>Regularly visit your doctor to assess overall health </li></ul><ul><li>Check for ways to reduce your risk and avoid any complications. </li></ul><ul><li>Exercise and walk daily. </li></ul>Dr. Sunita Gupta
  32. 33. Possible solutions Dr. Sunita Gupta
  33. 34. <ul><li>Any questions? </li></ul>Dr. Sunita Gupta
  34. 35. <ul><ul><ul><li>Thank You for listening </li></ul></ul></ul>Dr. Sunita Gupta
  35. 36. What diabetes can lead to … Dr. Sunita Gupta
  36. 37. One Effect of Diabetes Dr. Sunita Gupta
  37. 38. Fast fact: Neuropathy Dr. Sunita Gupta People who maintain intensive blood sugar control reduce their risk for neuropathy by 60%.